Dr. Gerald McKinley: Research with Indigenous Communities
Photo: Dr. Gerald McKinley
Interviewed by Will Chukra, Lac Seul First Nation Band Member
MD Candidate: Schulich School of Medicine & Dentistry
Dr. Gerald McKinley is an Assistant Professor and Anthropologist in the Department of Pathology and Laboratory Medicine at the Schulich School of Medicine and Dentistry. Dr. McKinley specializes in the social determinants of Indigenous health in Ontario, Canada, utilizing community-based and ethnographic research methodologies. I have had the pleasure of working with Dr. McKinley on research surrounding non-suicidal self-injury (NSSI) in Northwestern Ontario communities, with hopes of improving our understanding, detection, and treatment for NSSI in these communities. I interviewed Dr. Gerald McKinley to gain insight into his approach to working with Indigenous communities, the health inequities he has witnessed within these communities, and what needs to be done to help tackle these inequities. The following is a summary of our exchange.
What are some current research topics you are working with alongside Indigenous communities?
Gerald expressed that he maintains very close working relationships with two First Nations communities. One of the two is Walpole Island First Nation, where he is supporting the community’s climate change and human health impact study. He is also advising the community’s response to increased substance misuse during and following the Covid-19 pandemic. This response goes beyond criminalization and is looking to establish a more effective approach that focuses on the social determinants of health.
He has also been working alongside Whitefish River First Nation towards establishing a men’s substance misuse prevention program for the community’s public health system that utilizes social prescriptions based on the community’s traditions, rather than being strictly western-medicine-based. Gerald emphasized that this program’s main focus is to build a sense of community among the men, where they can support one another in a lifestyle that does not involve substance misuse.
These projects Gerald is working on are both based on the direction of these communities' concerns. While Gerald is trained in adolescent and adult suicide prevention, he stresses the importance of letting the communities guide his work based on the needs they have stated to him.
Given this guidance from Indigenous communities on what is needed, how do you ensure that these communities continue to maintain their involvement throughout the process of your work?
Gerald engages in what he calls “relationship-based research”, in which his primary focus before commencing with research is building relationships with the community members and leaders. Once these relationships are established, the responsibilities that follow are what guide his actions. Therefore, rather than focusing on his own research objectives, Gerald focuses on ensuring that he has strong relationships with the communities he works with. In doing so, he acts as a listener and learner, letting the communities teach him what their needs are and how they would like assistance. Even when there isn’t necessarily work to be done within the community, Gerald maintains a close relationship with members of the community, assuring he is available when his skillset as a researcher is needed. As a result, his research does not follow an approach that is built upon personal or institutionalized objectives such as obtaining publications or research grants that many researchers may be accustomed to. Instead, Gerald stresses that working with Indigenous communities requires letting the community set the research goals based on their needs, and thus as a researcher it is crucial to situate yourself as someone willing to learn about these needs and help as the community sees appropriate.
In learning from the Indigenous communities that you have worked with, to you, what is the most important lesson you have received in regards to your work?
Gerald had the opportunity to speak with an Elder of one of the communities he worked with in regards to a youth mental health project. In response to the above question, Gerald recited the Elder’s teaching: “don’t tell people what to do. It’s not about going in and telling people how to do things better, but going in and being the best you can be.”. Gerald went on to say that it would be incredibly disrespectful to the people of the community to go in and tell them how to live their life. Rather than going in as an “expert” that tells the people of the community how they should be living, it is essential that he, as well as other researchers involved with Indigenous communities, approaches their work as an opportunity to learn from them. Learning as much as he can from the communities is how he can make the greatest contribution to help, because not only will he have a deeper relationship with community members, but his expertise will then be utilized in a way that the community knows is most beneficial for them.
This teaching has related to Gerald’s work in several ways. Broadly speaking on substance misuse, Gerald spoke about how creating treatment options with Indigenous communities cannot simply have the punitive approach that many treatment plans have for drug misuse. Our Indigenous community members should not have to withstand punishment for failing to adhere to a treatment program that was not designed for their unique circumstances. Instead, Gerald proposes that we have treatment programs that act as a safe place that is available to our Indigenous communities. Therefore, rather than invoking or forcing treatment that might not work or even worsen people’s habits of substance misuse, these treatment programs would act as an alternative option that is available when people feel they could benefit from it. Ultimately, Gerald has been fortunate to learn that it is crucial to not tell these communities what to do, and instead, be there as someone who can provide support options that are wanted by the community, leading to greater potential for improving the well-being of the community.
In regards to your research, what are some of the health inequities that you have witnessed the most in these Indigenous communities due to the impacts of colonialization?
Gerald begins by recognizing that many of the health outcomes that Indigenous people currently face are not traditional to our heritage at all. For example, prior to the 1950s, diabetes had not been an issue in Indigenous communities. From an epidemiology standpoint, the increased prevalence of diabetes follows the relocation of Indigenous people off of homelands and onto First Nations reserves. One of the main reasons for this correlation is because the relocations caused a shift from Indigenous people’s traditional foods to the unhealthy store-bought foods that are often the only accessible options due to the geographical locations of these reserves, and are known to increase one’s risk of diabetes among other health concerns. Similar to diabetes, Gerald states that the health concerns for Indigenous people have emerged as our populations were relocated due to colonization, as this, along with the ongoing colonization experienced, has led to the loss of our ways of life that kept us from these health burdens we are now encountering.
Additionally, Gerald spoke on the current hub-based approach to providing health services for many Indigenous communities. Specifically, in Northwestern Ontario, many First Nations communities rely on the health services hubs of Sioux Lookout and Thunder Bay. This requires community members to come all the way to these hubs to receive health services, which often involves infrequent, long and expensive flights. Additionally, the lack of physicians able or willing to commute to these rural Indigenous communities often leads to few visits. As a result of these two points that Gerald brings to light, many Indigenous communities that he has worked with face health inequity in regards to a lack of accessible healthcare altogether, while the healthcare that is received is infrequent and often requires a commute out of their home community.
What do you think are some of the next steps that need to be done now to help decrease these inequities you have witnessed?
Gerald says the biggest problem comes down to money. For there to be equitable systems in Canada there needs to be a willingness by the government and institutes to spend money on Indigenous communities. Additionally, the people within the communities need to have control over how the money is allocated to benefit the communities. If someone from outside the community is dictating how this money is allocated, then there is no guarantee that these funds would be allocated appropriately, as only people who live in these communities can truly understand what is best for them.
There also needs to be responsiveness to these changes in funding, in that money that is allocated towards one aspect of healthcare, should be easily switched to fund another aspect of healthcare as issues arise. Gerald raises a point that health concerns within Indigenous communities can come and go very rapidly, so having that flexibility with allocating money would allow for better responsiveness to the various health issues that could arise. As an example, the rapid increase in substance misuse discussed earlier was a change Gerald has witnessed in many communities following the Covid-19 pandemic. However, the responsive treatment programs that Gerald is involved in could have likely been implemented faster had funding been equally responsive. Therefore, using an approach to funding that allows for rapid changes can make this responsiveness possible. As of right now, money is very siloed in what Gerald calls a “nightmare” to try and get funding switched from one health issue to another, taking away the responsiveness and autonomy that a community needs to manage money for its people.
Relating to Gerald’s work, this responsiveness is required due to the complexity of mental health that many Indigenous community members face. Rather than having a “one shoe fits all” approach that the funding currently permits, having more responsive funding that can be allocated to different aspects of mental health will then allow for treatment that is more appropriate for each individual’s unique mental health concerns, potentially saving many lives.
For other researchers who will be working with Indigenous communities, what is one final piece of advice you would give to them?
“Be humble and be themselves. It’s okay to not know everything when first starting your relationship with Indigenous communities. It is better to admit what you do not know, and by being yourself, trust will be built.”
